〔钱〕大抵疮疹属阳，出则为顺，故春夏病为顺，秋冬病为逆，冬月肾旺又盛寒，
病多归肾变黑。又当辨春脓 ，夏黑陷，秋 子，冬疹子，亦不顺也。凡疮疹只
出一般者善。先发脓 ，从发疹子者顺。先发水 ，后发疹子者逆。先发脓
，后水 多者顺，少者逆。先发水 ，后发 子多者逆，少者顺。先发疹子，
后发 子者顺。先发脓 ，后发 子者逆。（海藏云，此一句、足以知杂出者，诸脏相合而不齐
也，用药亦难矣。前断云∶五色各随五脏，亦有二色相合，或有三色，即无定也，此
与前后脓水、 疹大小不同，先后逆顺、大
意相若。）疮疹既出，而有逆顺者三，有时之顺逆。有虚实之顺逆。有出入之顺逆。
盖春夏阳气发生，疮疹为顺，秋冬阳气伏藏，疮疹为逆，此时之顺逆也。大小便闭
而能食者为实，为顺，大小便利而不能食者为虚，为逆，此虚实之顺逆也。疮疹出
者为顺，倒靥陷伏者为逆，此出入之顺逆也。〔万〕春夏为顺，秋冬为逆，此亦语
其生长收藏之理尔，岂有春夏皆顺而吉，秋冬皆逆而凶者乎，如春失奉生，夏失奉
长，则春夏亦逆，秋能养收，冬能养藏，则秋冬亦顺也。惟痘出一般，疏密得所，
不愆其期，证之顺也。痘出夹杂，带 带疹，稠密无缝，常失其期，证之逆也。噫！
春夏为顺，秋冬为逆。古人之言，岂真拘拘于时令之说耶，盖春夏发生之令也，秋
冬杀伐之令也，痘疮之出，起发者得春夏之令，所以为顺，陷伏者得秋冬之令，所
以为逆，其斯之谓欤。或云，春脓 （金克木），夏黑陷（水克火），秋 （火克金），冬疹（土克水），为
之逆者，此不经之谈。黑陷一证，四时不治，何但在夏邪，故非其时而有是证者，
气血和平，脏腑充实，莫不皆顺。如其时而有是证者，气衰血弱，脏腑虚惫者，莫
不皆逆。古人着书，有泛语其概者，有直道其实者，以意逆志，不以词害意可也，
钱氏小方脉之祖，医中之圣，无出其上者，宜若所着之论，更无可议矣，然亦有未
可尽信者，或泛语其概，或后人补之者也，如云∶先发脓 ，后发疹子者顺，脾肺
相生也。先疹子后 子者顺，心脾相生也。先发水 后发疹子者逆，肝克脾也。先
发脓 后发 子者逆，心克肺也。先发脓 后发水 多者顺，少者逆，肝多肺少木
乘金衰也。先水 后 子多者逆，少者顺，子衰母旺则顺，火乘木衰则逆也。此皆
泛语其概耳。其曰∶凡疮疹只出一般者善。此则直道其实者也，夫四毒之发，各有
其时，脓 最酷，疹次之，水 又次之， 为轻，分作四番，其毒则微，一并夹出，
其毒则甚矣。如云∶春夏为顺，秋冬为逆。春脓 ，金克木也。夏黑陷，水克火也。
秋子，火克金也。冬疹子，土克水也。此亦泛语其概耳。其曰∶黑者无问何时，
十难救其一二，此则直道其实者也。盖四者之毒，常乘天地不正之令而发，乃疫疠
之气，传染相似，时亦不得主之也。又云∶冬月肾旺又盛寒，病多归肾变黑。此则
后人因秋冬为逆，而杜撰以补之者也。钱氏谓∶春夏为顺，秋冬为逆者，盖以疮疹
属阳，春夏为阳，秋冬为阴，从其气则顺，违其气则逆，不过欲人常和暖而从春夏
之化，未尝拘定某证必某时为顺也。即如冬月变黑之说，则凡冬月出疮疹者，不分
轻重皆变黑而死，天地之气必不如是之隘，钱氏之意，亦不如是之拘也。但曰冬盛
寒，腠理闭塞，气血凝滞，非和暖疮难成就可也，何必以变黑归肾，独主于冬乎。
彼夏盛热，腠理开张，气血淖泽，亦有变黑归肾而死，何不云夏有黑陷乎。设云夏
火旺，肾不主事，则夏黑陷为逆之言，又何自而取乎。况黑陷为逆，四时皆然，亦
不独在于夏也。
【钱乙】大抵痘疮疹病属于阳证，痘疹透发出来就是顺证，所以春夏季节发病为顺证，秋冬季节发病为逆证。冬季肾气旺盛且寒气极盛，病情多归属于肾，表现为痘疹变黑。还应当辨别春季出脓疱、夏季出现黑陷、秋季出子（指痘疹颗粒）、冬季出疹子，这些情况也不属于顺证。凡是痘疹只出一类形态的为好。先出脓疱，随后出疹子的为顺证。先出水疱，随后出疹子的为逆证。先出脓疱，后出水疱多的为顺证，少的为逆证。先出水疱，后出子多的为逆证，少的为顺证。先出疹子，后出子的为顺证。先出脓疱，后出子的为逆证。（海藏说，这一句足以知道杂出者，是五脏之气相合而不整齐，用药也难以把握。前文断言：五色各随五脏，也有两色相合，或有三色，就没有定数了，这与前后脓水、疹子大小不同，先后逆顺的大意相近。）
痘疹既然发出，而有顺逆之分，有三种情况：有时令的顺逆，有虚实的顺逆，有出入的顺逆。大概春夏阳气生发，痘疹透出为顺；秋冬阳气伏藏，痘疹透出为逆，这是时令的顺逆。大小便闭塞而能进食的为实证，属顺证；大小便利畅而不能进食的为虚证，属逆证，这是虚实的顺逆。痘疹透发出来的为顺证，倒靥（痘顶凹陷）陷伏的为逆证，这是出入的顺逆。
【万全】春夏为顺，秋冬为逆，这也是论述生长收藏的道理罢了，难道有春夏都是顺吉、秋冬都是逆凶的吗？如果春季违背了生发的规律，夏季违背了生长的规律，那么春夏也是逆证；秋季能顺应收敛，冬季能顺应闭藏，那么秋冬也是顺证。只有痘疮出得一般均匀，疏密得当，不延误时期，才是顺证的征象。痘疮出得夹杂，带着脓疱带着疹子，稠密无缝，常常失去时期，才是逆证的征象。唉！古人说春夏为顺，秋冬为逆，难道真的是拘泥于时令的说法吗？大概春夏是生发的时令，秋冬是杀伐的时令，痘疮起发者得春夏之令，所以为顺；陷伏者得秋冬之令，所以为逆，说的就是这个意思吧。
有人说，春季出脓疱（金克木），夏季黑陷（水克火），秋季出子（火克金），冬季出疹子（土克水），称为逆证，这是不经之谈。黑陷一证，四季都难治，何止在夏季呢？所以非其时而有此证的，若气血和平，脏腑充实，无不皆顺。如其时而有此证的，若气衰血弱，脏腑虚惫的，无不皆逆。古人著书，有的泛泛概括整体情况，有的直接陈述事实真相，应当揣摩作者的心意，不要因文字而损害原意。钱氏是小方脉（儿科）之祖，医中之圣，没有超过他的，按理说他著的论述更无可议了，然而也有不可尽信的地方，有的是泛泛概括，有的是后人补充的。比如他说：先出脓疱，后出疹子者为顺，因为脾肺相生。先出疹子后出子者为顺，因为心脾相生。先出水疱后出疹子者为逆，因为肝克脾。先出脓疱后出子者为逆，因为心克肺。先出脓疱后出水疱多的为顺，少的为逆，因为肝多肺少，木乘金衰。先出水疱后出子多的为逆，少的为顺，因为子衰母旺则顺，火乘木衰则逆。这些都是泛泛概括的情况。
他说：“凡是痘疹只出一类形态的好。”这则是直接陈述事实真相。四毒（痘、疹、脓、水等）发作，各有其时，脓疱最剧烈，疹子次之，水疱又次之，子最轻，分四次发作，毒性就微弱；一并夹着出来，毒性就严重了。
如果说：“春夏为顺，秋冬为逆。春出脓疱，金克木也。夏黑陷，水克火也。秋出子，火克金也。冬出疹子，土克水也。”这也是泛泛概括。他说：“黑色无论何时出现，十难救一二”，这则是直接陈述事实真相。大概四种毒邪，常乘着天地不正之气而发作，像是疫疠之气传染相似，时令也不能主宰它。
又说：“冬季月肾气旺盛且寒气极盛，病情多归属于肾变黑。”这是后人因为秋冬为逆，而杜撰来补充的。钱氏说“春夏为顺，秋冬为逆”，是因为痘疹属阳，春夏为阳，秋冬为阴，顺从其气则为顺，违逆其气则为逆，不过是希望人们经常保持和暖而顺应春夏的化育，并没有拘泥于某种证候必定在某个时候为顺。就像冬季变黑的说法，那么凡是在冬季出痘疹的，不分轻重都变黑而死，天地之气必然不会如此狭隘，钱氏的本意也不会如此拘泥。只是说冬季寒气盛，腠理闭塞，气血凝滞，不是和暖的话痘疮难以成就罢了，何必以变黑归咎于肾，独主于冬季呢？那夏季热气盛，腠理开张，气血淖泽，也有变黑归肾而死的，为何不说夏季有黑陷呢？假如说夏季火旺，肾不主事，那么“夏季黑陷为逆”的说法，又从何而来呢？况且黑陷为逆，四季都是这样，也不独在于夏季。
[Qian Yi] Generally speaking, smallpox and measles belong to Yang syndromes. Eruption is considered a favorable course (Shun), so onset in spring and summer is favorable, while onset in autumn and winter is unfavorable (Ni). In winter, when Kidney Qi is prosperous and cold is severe, the disease often relates to the Kidney and manifests as blackening of the lesions. One must also distinguish between eruptions of pustules in spring, black depression in summer, papules in autumn, and macules in winter; these are also not favorable. It is good if the lesions appear in only one type. If pustules appear first followed by macules, it is favorable. If vesicles appear first followed by macules, it is unfavorable. If pustules appear first followed by many vesicles, it is favorable; if few, it is unfavorable. If vesicles appear first followed by many papules, it is unfavorable; if few, it is favorable. If macules appear first followed by papules, it is favorable. If pustules appear first followed by papules, it is unfavorable. (Haizang stated that this sentence suffices to know that mixed eruptions indicate the harmonization of the Five Zang organs but lack uniformity, making medication difficult. The previous assertion states: Each of the five colors corresponds to the Five Zang organs; there may also be two colors combined or three colors, with no fixed rule. This is similar in general intent to the differences in pus/water content, size of macules/papules, and their sequence of favorability/unfavorability.)
Once smallpox and measles have erupted, there are three aspects of favorable and unfavorable courses: those related to seasonal timing, those related to deficiency and excess, and those related to eruption and retraction. Generally, in spring and summer, Yang Qi arises, and eruption is favorable; in autumn and winter, Yang Qi hides, and eruption is unfavorable. This is the favorability/unfavorability of seasonal timing. Constipation of urine and stool with ability to eat indicates Excess syndrome and is favorable; free passage of urine and stool with inability to eat indicates Deficiency syndrome and is unfavorable. This is the favorability/unfavorability of deficiency and excess. Eruption is favorable; involution (Dao Ye) and depression are unfavorable. This is the favorability/unfavorability of eruption and retraction.
[Wan Quan] Spring and summer being favorable, autumn and winter being unfavorable, this merely discusses the principles of growth and storage. How can it be that all spring and summer cases are favorable and auspicious, while all autumn and winter cases are unfavorable and ominous? If spring fails to support generation and summer fails to support growth, then spring and summer are also unfavorable. If autumn supports gathering and winter supports storing, then autumn and winter are also favorable. Only when smallpox erupts uniformly, with appropriate density and without delay in timing, is it a sign of a favorable course. When smallpox erupts mixedly, accompanied by pustules and macules, densely packed without gaps, and frequently missing the proper timing, it is a sign of an unfavorable course. Alas! The ancients said spring and summer are favorable, autumn and winter are unfavorable. Was this truly rigid adherence to seasonal theories? Essentially, spring and summer are seasons of generation, while autumn and winter are seasons of harvesting and killing. Smallpox that rises and develops obtains the command of spring and summer, hence it is favorable; that which depresses and sinks obtains the command of autumn and winter, hence it is unfavorable. Is this not what is meant?
Some say that pustules in spring (Metal overcomes Wood), black depression in summer (Water overcomes Fire), papules in autumn (Fire overcomes Metal), and macules in winter (Earth overcomes Water) are unfavorable. This is unscientific talk. Black depression is untreatable in all four seasons, not just in summer. Therefore, if such symptoms occur out of season, and Qi and Blood are harmonious and Zang-Fu organs are solid, they are all favorable. If such symptoms occur in season, and Qi is weak and Blood deficient, with Zang-Fu organs exhausted, they are all unfavorable. Ancient authors wrote some works to generalize broadly and others to state facts directly. One should infer the author's intent from their words, not let the words obscure the intent. Qian was the ancestor of pediatric medicine and a sage among physicians, unsurpassed. His writings should theoretically be beyond reproach, yet there are parts that cannot be fully trusted, either because they are broad generalizations or additions by later generations. For instance, he stated: "Pustules first, then macules is favorable, due to the mutual generation of Spleen and Lung." "Macules first, then papules is favorable, due to the mutual generation of Heart and Spleen." "Vesicles first, then macules is unfavorable, due to Liver overcoming Spleen." "Pustules first, then papules is unfavorable, due to Heart overcoming Lung." "Pustules first, then many vesicles is favorable, few is unfavorable, due to Liver excess and Lung deficiency, where Wood attacks weakened Metal." "Vesicles first, then many papules is unfavorable, few is favorable, due to offspring weakness and mother prosperity being favorable, while Fire attacking weakened Wood is unfavorable." These are all broad generalizations.
He stated: "If lesions appear in only one type, it is good." This states the fact directly. The four types of toxins (smallpox, macules, pustules, vesicles) erupt at different times. Pustules are most severe, macules next, vesicles next, and papules lightest. If separated into four stages, the toxin is mild; if erupted together mixedly, the toxin is severe.
Regarding the statement: "Spring and summer are favorable, autumn and winter are unfavorable. Spring pustules, Metal overcomes Wood. Summer black depression, Water overcomes Fire. Autumn papules, Fire overcomes Metal. Winter macules, Earth overcomes Water." This is also a broad generalization. He stated: "Black lesions, regardless of time, ten cases save one or two." This states the fact directly. Generally, the four toxins often erupt driven by abnormal Qi of heaven and earth, resembling epidemic Qi transmission, which seasonal timing cannot control.
It is also said: "In winter, Kidney Qi is prosperous and cold is severe, so the disease often returns to the Kidney and turns black." This was fabricated by later generations to supplement the idea that autumn and winter are unfavorable. Qian's statement that "spring and summer are favorable, autumn and winter are unfavorable" is because lesions belong to Yang, spring and summer are Yang, and autumn and winter are Yin. Following the Qi makes it favorable; opposing it makes it unfavorable. He merely wished for people to maintain warmth and follow the transformation of spring and summer, without rigidly stipulating that a specific symptom must be favorable in a specific season. For example, regarding the theory of winter blackening, if all winter eruptions turned black and caused death regardless of severity, the Qi of heaven and earth would not be so narrow-minded, nor would Qian's intent be so rigid. He simply meant that in winter, severe cold closes the pores (Cou Li), stagnates Qi and Blood, and without warmth, the lesions cannot mature. Why attribute blackening solely to the Kidney and exclusively to winter? In summer, heat opens the pores and makes Qi and Blood fluid; there are also cases of blackening returning to the Kidney causing death. Why not speak of summer black depression? If one argues that summer Fire is prosperous and the Kidney does not govern, then where does the statement "summer black depression is unfavorable" come from? Moreover, black depression as unfavorable applies to all four seasons, not just summer.